{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,11]],"date-time":"2026-11-11T21:59:15Z","timestamp":1794434355943,"version":"4.9.1"},"reference-count":59,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,4,5]],"date-time":"2024-04-05T00:00:00Z","timestamp":1712275200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Excessive daytime sleepiness (EDS) is a cause of low quality of life among obstructive sleep apnoea (OSA) patients. Current methods of assessing and predicting EDS are limited due to time constraints or differences in subjective experience and scoring. Electroencephalogram (EEG) power spectral densities (PSDs) have shown differences between OSA and non-OSA patients, and fatigued and non-fatigued patients. Therefore, polysomnographic EEG PSDs may be useful to assess the extent of EDS among patients with OSA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients presenting to Israel Loewenstein hospital reporting daytime sleepiness who recorded mild OSA on polysomnography and undertook a multiple sleep latency test. Alpha, beta, and delta relative powers were assessed between patients categorized as non-sleepy (mean sleep latency (MSL) \u226510\u2009min) and sleepy (MSL &amp;lt;10\u2009min).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>139 patients (74% male) were included for analysis. 73 (53%) were categorized as sleepy (median MSL 6.5\u2009min). There were no significant differences in demographics or polysomnographic parameters between sleepy and non-sleepy groups. In multivariate analysis, increasing relative delta frequency power was associated with increased odds of sleepiness (OR 1.025 (95% CI 1.024\u20131.026)), while relative alpha and beta powers were associated with decreased odds. The effect size of delta PSD on sleepiness was significantly greater than that of either alpha or beta frequencies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Delta PSD during polysomnography is significantly associated with a greater degree of objective daytime sleepiness among patients with mild OSA. Further research is needed to corroborate our findings and identify the direction of potential causal correlation between delta PSD and EDS.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2024.1367860","type":"journal-article","created":{"date-parts":[[2024,4,5]],"date-time":"2024-04-05T04:58:31Z","timestamp":1712293111000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Excessive daytime sleepiness is associated with relative delta frequency power among patients with mild OSA"],"prefix":"10.3389","volume":"15","author":[{"given":"Timothy","family":"Howarth","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masoumeh","family":"Tashakori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tuomas","family":"Karhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matias","family":"Rusanen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henna","family":"Pitk\u00e4nen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arie","family":"Oksenberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sami","family":"Nikkonen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,4,5]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"608","DOI":"10.3978\/j.issn.2072-1439.2012.10.07","article-title":"Excessive daytime sleepiness in sleep disorders","volume":"4","author":"Slater","year":"2012","journal-title":"J Thorac Dis"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"zsx134","DOI":"10.1093\/sleep\/zsx134","article-title":"Risk of motor vehicle accidents related to sleepiness at the wheel: a systematic review and Meta-analysis","volume":"40","author":"Bioulac","year":"2017","journal-title":"Sleep"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1013","DOI":"10.5664\/jcsm.3072","article-title":"Excessive daytime sleepiness increases the risk of motor vehicle crash in obstructive sleep apnea","volume":"9","author":"Ward","year":"2013","journal-title":"J Clin Sleep Med"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"235","DOI":"10.5664\/jcsm.7624","article-title":"Comorbidities, health-related quality of life, and work productivity among people with obstructive sleep apnea with excessive sleepiness: findings from the 2016 US National Health and wellness survey","volume":"15","author":"Stepnowsky","year":"2019","journal-title":"J Clin Sleep Med"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1186\/s12883-022-02827-7","article-title":"Examining the impact of excessive daytime sleepiness on utility scores in patients with obstructive sleep apnoea and\/or narcolepsy in five European countries","volume":"22","author":"Cambron-Mellott","year":"2022","journal-title":"BMC Neurol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1016\/j.sleep.2007.01.009","article-title":"The impact of obstructive sleep apnea and daytime sleepiness on work limitation","volume":"9","author":"Mulgrew","year":"2007","journal-title":"Sleep Med"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"zsy083","DOI":"10.1093\/sleep\/zsy083","article-title":"The economic cost of inadequate sleep","volume":"41","author":"Hillman","year":"2018","journal-title":"Sleep"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"101275","DOI":"10.1016\/j.smrv.2020.101275","article-title":"The economic and societal burden of excessive daytime sleepiness in patients with obstructive sleep apnea","volume":"51","author":"L\u00e9ger","year":"2020","journal-title":"Sleep Med Rev"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"e002298","DOI":"10.1136\/bmjopen-2012-002298","article-title":"Psychological distress mediates the association between daytime sleepiness and consumption of sweetened products: cross-sectional findings in a Catholic middle-eastern Canadian community","volume":"3","author":"Moubarac","year":"2013","journal-title":"BMJ Open"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"19m02531","DOI":"10.4088\/PCC.19m02531","article-title":"Association of Excessive Daytime Sleepiness with Psychological Distress in medical students","volume":"22","author":"Sameer","year":"2020","journal-title":"Prim Care Companion CNS Disord"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1016\/j.smrv.2008.09.001","article-title":"Hypersomnia across mood disorders: a review and synthesis","volume":"13","author":"Kaplan","year":"2009","journal-title":"Sleep Med Rev"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"772","DOI":"10.1177\/0004867413490036","article-title":"The relationship between excessive daytime sleepiness and depressive and anxiety disorders in women","volume":"47","author":"Hayley","year":"2013","journal-title":"Aust N Z J Psychiatry"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1314","DOI":"10.1111\/resp.12829","article-title":"Association of daytime sleepiness with obstructive sleep apnoea and comorbidities varies by sleepiness definition in a population cohort of men","volume":"21","author":"Adams","year":"2016","journal-title":"Respirology"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"575","DOI":"10.5664\/jcsm.6546","article-title":"Associations of undiagnosed obstructive sleep apnea and excessive daytime sleepiness with depression: an Australian population study","volume":"13","author":"Lang","year":"2017","journal-title":"J Clin Sleep Med"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"710435","DOI":"10.3389\/fpsyt.2021.710435","article-title":"Excessive daytime sleepiness in depression and obstructive sleep apnea: more than just an overlapping symptom","volume":"12","author":"Zhang","year":"2021","journal-title":"Front Psychiatry"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1387","DOI":"10.1007\/s11325-015-1155-5","article-title":"Prevalence of excessive sleepiness is higher whereas insomnia is lower with greater severity of obstructive sleep apnea","volume":"19","author":"Bjorvatn","year":"2015","journal-title":"Sleep Breath"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1186\/s40248-019-0172-9","article-title":"Obstructive sleep apnea and comorbidities: a dangerous liaison","volume":"14","author":"Bonsignore","year":"2019","journal-title":"Multidiscip Respir Med"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"00646","DOI":"10.1183\/23120541.00646-2021","article-title":"Multimorbidity and overall comorbidity of sleep apnoea: a Finnish nationwide study","volume":"8","author":"Palom\u00e4ki","year":"2022","journal-title":"ERJ Open Res"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"222","DOI":"10.3132\/pcrj.2007.00045","article-title":"Prevalence of sleep-related symptoms in a primary care population \u2014 their relation to asthma and COPD","volume":"16","author":"Karachaliou","year":"2007","journal-title":"Prim Care Respir J"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1111\/j.1365-2869.2008.00663.x","article-title":"Determinants of subjective sleepiness in suspected obstructive sleep apnoea","volume":"17","author":"Koutsourelakis","year":"2008","journal-title":"J Sleep Res"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1177\/1054773811419842","article-title":"Determinants of excessive daytime sleepiness and fatigue in adults with heart failure","volume":"21","author":"Riegel","year":"2012","journal-title":"Clin Nurs Res"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1089196","DOI":"10.1155\/2016\/1089196","article-title":"Predictors of increased daytime sleepiness in patients with chronic obstructive pulmonary disease: a cross-sectional study","volume":"2016","author":"Enz","year":"2016","journal-title":"Sleep Disord"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"389","DOI":"10.1111\/jsr.12039","article-title":"Residual sleepiness in sleep apnea patients treated by continuous positive airway pressure","volume":"22","author":"Gasa","year":"2013","journal-title":"J Sleep Res"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1062","DOI":"10.1183\/09031936.00016808","article-title":"Prevalence of residual excessive sleepiness in CPAP-treated sleep apnoea patients: the French multicentre study","volume":"33","author":"P\u00e9pin","year":"2009","journal-title":"Eur Respir J"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1700348","DOI":"10.1183\/13993003.00348-2017","article-title":"Predictors of sleepiness in obstructive sleep apnoea at baseline and after 6 months of continuous positive airway pressure therapy","volume":"50","author":"Budhiraja","year":"2017","journal-title":"Eur Respir J"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"757","DOI":"10.1513\/AnnalsATS.202006-696FR","article-title":"Excessive daytime sleepiness in obstructive sleep apnea. Mechanisms and clinical management","volume":"18","author":"Lal","year":"2021","journal-title":"Ann Am Thorac Soc"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"e13431","DOI":"10.1111\/jsr.13431","article-title":"How sleepy patients differ from non-sleepy patients in mild obstructive sleep apnea?","volume":"31","author":"Oksenberg","year":"2022","journal-title":"J Sleep Res"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1007\/s41782-019-00068-2","article-title":"Clinical and polysomnographic correlates of subjective sleepiness in mild obstructive sleep apnea","volume":"3","author":"Omobomi","year":"2019","journal-title":"Sleep Vigil"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1135","DOI":"10.5664\/jcsm.7806","article-title":"Severity of desaturations reflects OSA-related daytime sleepiness better than AHI","volume":"15","author":"Kainulainen","year":"2019","journal-title":"J Clin Sleep Med"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1016\/j.sleep.2020.07.015","article-title":"Power spectral densities of nocturnal pulse oximetry signals differ in OSA patients with and without daytime sleepiness","volume":"73","author":"Kainulainen","year":"2020","journal-title":"Sleep Med"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"4758","DOI":"10.1038\/s41598-021-83980-w","article-title":"A high-density electroencephalography study reveals abnormal sleep homeostasis in patients with rapid eye movement sleep behavior disorder","volume":"11","author":"Valomon","year":"2021","journal-title":"Sci Rep"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1097\/WNP.0b013e3181c298fe","article-title":"EEG power spectra at early stages of depressive disorders","volume":"26","author":"Grin-Yatsenko","year":"2009","journal-title":"J Clin Neurophysiol"},{"key":"ref33","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1109\/IBIOMED50285.2020.9487614","article-title":"Electroencephalographic spectral analysis to help detect depressive disorder","volume-title":"2020 3rd international conference on biomedical engineering (IBIOMED)","author":"Apsari","year":"2020"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1038\/nature10009","article-title":"Local sleep in awake rats","volume":"472","author":"Vyazovskiy","year":"2011","journal-title":"Nature"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"2117","DOI":"10.1038\/s41598-022-05378-6","article-title":"Difference in spectral power density of sleep electroencephalography between individuals without insomnia and frequent hypnotic users with insomnia complaints","volume":"12","author":"Kang","year":"2022","journal-title":"Sci Rep"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"1516","DOI":"10.1016\/j.sleep.2015.09.005","article-title":"The diagnostic value of power spectra analysis of the sleep electroencephalography in narcoleptic patients","volume":"16","author":"Christensen","year":"2015","journal-title":"Sleep Med"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"9120","DOI":"10.1038\/s41598-023-34716-5","article-title":"Machine learning polysomnographically-derived electroencephalography biomarkers predictive of epworth sleepiness scale","volume":"13","author":"Araujo","year":"2023","journal-title":"Sci Rep"},{"key":"ref38","article-title":"Detection of excessive daytime sleepiness in resting-state EEG recordings: a novel machine learning approach using specific EEG sub-bands and channels","volume-title":"AMCIS 2020 proceedings [internet]","author":"Breitenbach","year":"2020"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1016\/j.smrv.2013.08.002","article-title":"Evaluation of the measurement properties of the Epworth sleepiness scale: a systematic review","volume":"18","author":"Kendzerska","year":"2014","journal-title":"Sleep Med Rev"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1093\/sleep\/28.1.113","article-title":"Practice parameters for clinical use of the multiple sleep latency test and the maintenance of wakefulness test","volume":"28","author":"Littner","year":"2005","journal-title":"Sleep"},{"key":"ref41","first-page":"371","article-title":"The ten-twenty electrode system of the international federation","volume":"10","author":"Jasper","year":"1958","journal-title":"Electroencephalagr Clin Neurophysiol Suppl"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1016\/j.neuron.2011.02.043","article-title":"Regional slow waves and spindles in human sleep","volume":"70","author":"Nir","year":"2011","journal-title":"Neuron"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"803507","DOI":"10.3389\/fnins.2021.803507","article-title":"Sleep quality and Electroencephalogram Delta power","volume":"15","author":"Long","year":"2021","journal-title":"Front Neurosci"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"S16","DOI":"10.5664\/JCSM.1346","article-title":"Delta wave power: an independent sleep phenotype or epiphenomenon?","volume":"7","author":"Davis","year":"2011","journal-title":"J Clin Sleep Med"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1016\/j.sleep.2006.03.016","article-title":"Chronic fatigue, unrefreshing sleep and nocturnal polysomnography","volume":"7","author":"Guilleminault","year":"2006","journal-title":"Sleep Med"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"1135","DOI":"10.1183\/09031936.98.11051135","article-title":"Spectral analysis of wakefulness and REM sleep EEG in patients with sleep apnoea syndrome","volume":"11","author":"Morisson","year":"1998","journal-title":"Eur Respir J"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1007\/s11325-010-0335-6","article-title":"Quantitative spectral analysis of vigilance EEG in patients with obstructive sleep apnoea syndrome","volume":"15","author":"Xiromeritis","year":"2011","journal-title":"Sleep Breath"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"310","DOI":"10.3389\/fnins.2020.00310","article-title":"Sleep electroencephalographic response to respiratory events in patients with moderate sleep apnea\u2013hypopnea syndrome","volume":"14","author":"Zhou","year":"2020","journal-title":"Front Neurosci"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"230","DOI":"10.3414\/ME09-01-0054","article-title":"Classification of sleep stages using multi-wavelet time frequency entropy and LDA","volume":"49","author":"Fraiwan","year":"2010","journal-title":"Methods Inf Med"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"1797","DOI":"10.3390\/app10051797","article-title":"Classification of brainwaves for sleep stages by high-dimensional FFT features from EEG signals","volume":"10","author":"Delimayanti","year":"2020","journal-title":"Appl Sci"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1016\/S1631-0691(02)01438-5","article-title":"EEG source identification: frequency analysis during sleep","volume":"325","author":"Coatanhay","year":"2002","journal-title":"C R Biol"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1590\/S0004-282X1991000200002","article-title":"Night sleep electroencephalogram power spectral analysis in excessive daytime sleepiness disorders","volume":"49","author":"Reim\u00e3o","year":"1991","journal-title":"Arq Neuropsiquiatr"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1016\/j.biopsycho.2007.11.007","article-title":"Night-time right hemisphere superiority and daytime left hemisphere superiority: a repatterning of laterality across wake\u2013sleep\u2013wake states","volume":"77","author":"Casagrande","year":"2008","journal-title":"Biol Psychol"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1016\/j.biopsycho.2012.08.009","article-title":"Increased EEG sigma and beta power during NREM sleep in primary insomnia","volume":"91","author":"Spiegelhalder","year":"2012","journal-title":"Biol Psychol"},{"key":"ref55","doi-asserted-by":"publisher","first-page":"521","DOI":"10.9758\/cpn.2021.19.3.521","article-title":"Relationship between the spectral power density of sleep electroencephalography and psychiatric symptoms in patients with breathing-related sleep disorder","volume":"19","author":"Kang","year":"2021","journal-title":"Clin Psychopharmacol Neurosci"},{"key":"ref56","doi-asserted-by":"publisher","first-page":"1273623","DOI":"10.3389\/fneur.2023.1273623","article-title":"New insights and potential clinical implications of the odds ratio product","volume":"14","author":"Younes","year":"2023","journal-title":"Front Neurol"},{"key":"ref57","doi-asserted-by":"publisher","first-page":"641","DOI":"10.5665\/sleep.4588","article-title":"Odds ratio product of sleep EEG as a continuous measure of sleep state","volume":"38","author":"Younes","year":"2015","journal-title":"Sleep"},{"key":"ref58","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1111\/j.1365-2869.2007.00594.x","article-title":"Trait interindividual differences in the sleep physiology of healthy young adults","volume":"16","author":"Tucker","year":"2007","journal-title":"J Sleep Res"},{"key":"ref59","doi-asserted-by":"publisher","first-page":"zsac059","DOI":"10.1093\/sleep\/zsac059","article-title":"Sleep architecture based on sleep depth and propensity: patterns in different demographics and sleep disorders and association with health outcomes","volume":"45","author":"Younes","year":"2022","journal-title":"Sleep"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2024.1367860\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,5]],"date-time":"2024-04-05T04:59:41Z","timestamp":1712293181000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2024.1367860\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,5]]},"references-count":59,"alternative-id":["10.3389\/fneur.2024.1367860"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2024.1367860","relation":{"has-part":[{"id-type":"doi","id":"https:\/\/doi.org\/10.3389\/fneur.2024.1367860.s001","asserted-by":"subject"}]},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,5]]},"article-number":"1367860"}}